目的 探讨右美托咪定联合静吸复合全身麻醉用于高原地区腹腔镜治疗成人腹股沟斜疝的临床效果。方法 选取2020-12至2022-12武警西藏总队医院收治的97例行腹腔镜治疗腹股沟斜疝的患者为对象,按照随机数字表法分为观察组(n=48)和对照组(n=49),观察组给予右美托咪定联合静吸复合全身麻醉,对照组给予静吸复合全身麻醉,比较两组患者的一般情况、麻醉质量、血流动力学、应激反应、炎症因子及并发症发生率。结果 观察组麻醉起效时间[(6.37±1.24)min]和拔管时间[(13.88±4.30)min]均短于对照组[(9.12±3.45)min;(21.27±7.30)min],差异有统计学意义(P<0.05);观察组麻醉诱导时血压[(126.30±12.45)/(76.38±6.80)mmHg)]高于对照组[(120.15±10.37)/(71.44±4.93)/mmHg],观察组心率[(73.41±10.07)次/min]、平均动脉压[(86.39±14.07)mmHg]、心指数(2.38±0.77)低于对照组[(79.60±11.53)次/min]、(98.13±17.22)mmHg、(2.76±0.93)];麻醉诱导期两组患者应激指标及炎症因子水平比较差异无统计学意义(P>0.05);麻醉苏醒期观察组患者应激指标皮质醇、血管紧张素Ⅱ和醛固酮,炎症因子白介素-6、C反应蛋白和肿瘤坏死因子-α及并发症发生率低于对照组(P<0.05)。结论 高原右美托咪定联合静吸复合全身麻醉用于成人腹股沟斜疝腹腔镜可稳定患者血液动力学,减少应激反应及炎症因子水平同时可以降低麻醉并发症发生率,提高麻醉安全性。
Abstract
Objective To study the clinical effect of dexmedetomidine and general anesthesia combined with inhalation in laparoscopic treatment of adults with indirect inguinal hernia in plateau. Methods A total of 97 patients who were treated with laparoscopic treatment of indirect inguinal hernia in Tibet Autonomous Regional Corps Hospital of Chinese People’s Armed Police Force from December 2020 to December 2022 were selected as subjects, and divided into observation group (n=48) and control group (n=49) by random number table method. The control group were given general anesthesia combined with inhalation, while the observation group were given dexmedetomidine and general anesthesia combined with inhalation. The general condition, anesthesia quality, hemodynamics, stress response, inflammatory factors and incidence of complications were compared between the two groups. Results The onset time of anesthesia [(6.37±1.24)min] and extubation time [(13.88±4.30) min] in the observation group were smaller than those in the control group [ (9.12±3.45) min and (21.27±7.30)min; P<0.05]. The blood pressure during intoxication time in the observation group [(126.30±12.45)/(76.38±6.80)mmHg] was higher than that in the control group [(120.15±10.37)/(71.44±4.93)mmHg]. The heart rate[(73.41±10.07) times/min], mean arterial pressure [(86.39±14.07)mmHg] and heart index (2.38±0.77) in the observation group were lower than those in the control group [(79.60±11.53)times/min,(98.13±17.22)mmHg and(2.76±0.93). There was no significant difference in stress indexes and inflammatory factors between the two groups during anesthesia induction period(P>0.05). During anesthesia recovery period, the stress index cortisol, Ang Ⅱ and ALDO, inflammatory factor IL-6, CRP and TNF-α, and complication rate in the observation group were lower than those in the control group(P<0.05). Conclusions Dexmedetomidine and general anesthesia combined with inhalation can stabilize hemodynamics, reduce the levels of stress response and inflammatory factors, reduce the incidence of anesthesia complications and improve the safety of anesthesia in adult patients with indirect inguinal hernia in plateaus.
关键词
右美托咪定 /
静吸复合全身麻醉 /
高原 /
腹股沟斜疝 /
腹腔镜手术
Key words
dexmedetomidine /
general anesthesia combined with inhalation /
plateau /
indirect inguinal hernia /
laparoscope
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